Objective To summarize the experience in the perioperative nursing of one-stage bilateral total hip arthroplaaty (THA) for the systemic lupus erythematosus (SLE) patients with avascular necrosis of the femoral head (ANFH).Methods From June 1998 to April 2007,17 cases of patients who were diagnosed as SLE with bilateral ANFH were treated by one-stage bilateral THA.Perioperative nursing included psychological support,diet control,observation and nursing of various complications,correct functional exercise and health education.Harris score and SF-36 score were evaluated before and after operation.Results There were 2 cases with delayed incision healing,1 with early prosthesis dislocation,1 with thigh pain for 10 months and 1 with acute renal failure postoperatively,which were improved and recovered after proper treatments.Asymptomatic deep vein thrombosis (DVT) in low extremities were detected by color Doppler ultrasonography in 6 cases.There were no pulmonary embolism and no deep infection around prosthesis.There was no Addisonian crisis postoperatively.The pain was relieved and the motion of joint was improved during follow-up.There was no radiological evidence of implant loosening.The Harris hip score and SF-36 score greatly alleviated after operation.All patients were followed up and the mean follow-up time was 28 months.Conclusions One-stage bilateral THA has good results for the patients with SLE and AVNH.Strengthening of perioperative nursing contributed to improvement of success rate of surgery and reduction of complication.

How is it possible to bring about a harmonious development of science-tech education and humanity education in a way in medical education?One key to this issue is to map out a sound curriculum plan of humanity education.There is an analysis of curriculum plan in several foreign countries, such as America,Britain,France and Japan, in respect of training objectives, curriculum assignments,teaching contents and the methods are to be used for learning, teaching and evaluation.Finally,the comparison may shed light on the reform of our countrys curriculum plan.

Objective To investigate the effect and mechanism of dibenzazepines ( DBZ ) injection on pulmonary hypertension in rat. Methods Rat models of pulmonary hypertension were established, and 30 male rats were randomly divided into 3 groups: normal control group with saline injection, pulmonary hypertension model control group with hypoxia treatment and saline injection, DBZ group with hypoxia treatment and DBZ injection. The right ventricular pressure was determined by ultrasound cardiogram.Pulmonary arterial remodeling was detected by HE staining.Proliferation cell nuclear antigen and CCK-8 in pulmonary arterial smooth muscle cells were detected by Western blotting. Results The right ventricular pressure of pulmonary hypertension group was significantly increased compared with normal control group [(4.60±0.16) kPa vs. (3.37±0.18) kPa(P<0.01)].After hypoxia treatment, pulmonary arterial remodeling and proliferation of pulmonary arterial smooth muscle cells of the rats of pulmonary hypertension group were augmented remarkably. Rats from DBZ group showed reductions in right ventricular pressure, amelioration in pulmonary arterial remodeling and suppression in proliferation of pulmonary arterial smooth muscle cells. The proliferation of rat pulmonary artery smooth muscle cells decreased significantly in DBZ treated group [(2.073±0.064) vs.(4.392±0.013)] compared with model control group (P<0.05). Conclusion Notch pathway takes part in the process of pulmonary hypertension, and DBZ injection can significantly suppress the proliferation of pulmonary artery smooth muscle cells with a protective effect on pulmonary hypertension.

Objective To investigate the role of microRNA-21(miR-21) on cardiac fibroblast proliferation and dif-ferentiation in the mouse model of myocardial infarction. Methods The mouse model of myocardial infarction (MI) was es-tablished by ligation of the left coronary artery in male C57BL/6 mice(MI group). The echocardiographic assessment and his-tological evaluation were performed after ligation. The expression levels of miR-21 were measured by quantitative real-time PCR in the various myocardial tissues. The cardiac fibroblasts transfected with miR-21 mimic were over-expressed miR-21. The proliferation was assessed by immunostaining for 5-ethynyl-2’-deoxyuridine (EdU). Western blot assay was used to detect the expression ofα-SMA and Smad7 in the cardiac fibroblasts,and compared with control group and blank group. Results The expression of miR-21 was significantly increased in border area in MI group than that of sham group [(6.043 ± 0.231)×10-4 vs(1.620±0.451)×10-4,P<0.01]. There was a higher expression of miR-21 in miR-21 mimic group than that of control group and blank group [(4.839±0.705)×10-4 vs(1.143±0.064)×10-4 vs(1.017±0.201)×10-4,P<0.01]. The EdU positive rate was significantly higher in miR-21 mimic group than that of control group and blank group[(27.892±1.645)%vs(12.553 ± 1.227)% vs(13.946 ± 1.550)%,P<0.01]. The expression of α-SMA was significantly increased in miR-21 mimic group, while the expression of Smad7, a target gene of miR-21, was significantly decreased. Conclusion The over-expression of miR-21 in cardiac fibroblasts disrupts TGF-βsignaling pathway by reducing the expression of Smad7, which promotes the proliferation and differentiation of cardiac fibroblast, and finally regulates cardiac remodeling after myocardial infarction.

Objective To compare the operative and conservative treatments for senile dens fractures of Anderson-D Alonzo type Ⅱ or Ⅲ using Meta-analysis.Methods A literature search was conducted in PubMed,Embase,Web of Science,Cochrane Library,Wanfang Data and CNKI for studies on senile dens fractures of Anderson-D Alonzo type Ⅱ or Ⅲ from the earliest records through June 2016.The relative studies identified were screened by 2 independent authors.The quality of these articles was evaluated using modified Newcastle-Ottawa scale,and the meta-analysis was conducted using Review Manager 5.3.Results A total of 22 articles were brought into this Meta-analysis.The union rate was significantly higher in the operative group than in the conservative group[OR =0.30,95％ CI(0.20,0.44),P ＜ 0.001];the mortality in the operative group was significantly lower than in the conservative group[OR =0.61,95％ CI (0.39,0.96),P=0.03];the complication rate was similar in both groups[OR=1.09,95％ CI(0.76,1.57),P ＜ 0.46].The heterogeneity of all the 3 indexes was low.In the subgroup analysis,the union rate was significantly higher in posterior operations than in anterior operations or conservative treatments (P ＜ 0.05).Conclusion For the elderly patients with dens fracture of type Ⅱ or Ⅲ who can tolerate surgery,operative treatment may be more suitable because it can lead to much better prognosis.

Objective To construct the eukaryotic expression plasmids of human Fas and TNFR1 gene(pcDNA3.0-hFas and pcDNA3.0-hTNFR1)and microRNA(miRNA)expression plasmid of hFas and hTNFR1 named p-hFasmiRNA and p-hTNFR1miRNA,and to investigate their inhibitory effects in vitro.Methods The eukaryotic expression plasmids of human Fas and TNFR1 gene were constructed(pcDNA3.0-hFas and pcDNA3.0-hTNFR1)and have been shown successfully to express hFas and hTNFR1 protein.miRNA expression plasmids of hFas and hTNFR1 named p-hFasmiRNA and p-hTNFR1miRNA complimentary to the sequence responsible for hFas and hTNFR1 respective were constructed,meanwhile irrelevant miRNA plasmid was used as a control.By respective co-transfection of p-hFasmiRNA and pcDNA3.0-hFas,p-hTNFR1 miRNA and pcDNA3.0-hTNFR1 expression construct into 293T cells,the inhibition of hFas and hTNFR1 expression was analyzed by real-time PCR and Western blot.Results The experiments showed the significant inhibitory effect of p-hFasmiRNA on hFas and p-hTNFR1miRNA on hTNFR1 expression at 48 h post-transfection both at RNA level and protein level as well in 293T cell lines with the inhibitory efficiency being as high as 87% for hFas and 80% for hTNFR1,respectively.Conclusion The p-hFasmiRNA and p-hTNFR1miRNA were constructed successfully,and it was verified that they could specifically inhibit the hFas and hTNFR1 expression at the cellular level.

Previous study on TNFRl-mediated hepatocyte apoptosis has been implicated in the development of fulminant viral hepatitis.To interfere with the potentially effective target,plasmid named p-mTNFR1shRNA complimentary to the sequence responsible for mTNFR1 was also constructed and further confirmed by sequence analysis.To investigate the effect of mTNFR1shRNA plasmid on mTNFR1 expression in vivo and the disease progress in MHV-3 induced fulminant hepatitis mice model.By hydrodynamic injection of mTNFRlshRNA plasmid,the survival rate of mice,hepatic pathological change were examined and compared between mice with/without mTNFR1 shRNA plasmid intervention.The expression of mTNFR1 was detected by Real-time PCR,immunohistochemistry staining.The mTNFR1 shRNA plasmid significantly reduced mTNFR1 expression in vivo,markedly ameliorates inflammatory infiltration,prolonged the survival time period and elevated the survival rate from 0 up to 13.3% in Balb/cJ mice with MHV-3 induced fulminant hepatitis.This study was designed to explore the opportunity of RNA interference technique in inhibiting TNFR1 expression,which has been reported to be involved in the development of a variety of diseases including fulminant viral hepatitis and severe chronic hepatitis B.

BACKGROUND:Transforaminal lumbar interbody fusion(TLIF)can be applied in any lumbar segment,and retain integrity of lateral vertebral plate and zygapophysiai joints.However,few studies have been conducted about the biomechanical performance.OBJECTIVE:To explore the stability of lumbar intervertebral segment following TLIF appHed bilateral and unilateral transpedicular screws fixation.DESIGN,TIME AND SETTING:Biomechanical test was performed at the Institute of Biomechanics,Shanghai University and Nantong University between August 2005 and April 2006.MATERIALS:Twenty samples of fresh one-month-old calf lumbar vertebra.METHODS:Twenty samples of calf lumbar vertebra underwent TLIF alone,TLIF in combination with bilateral or unilateral transpedicular screws fixation.Biomechanical test was performed on spinal three dimensional motion testing machine.MAIN OUTCOME MEASURES:Stress,displacement.strain and torsion angle were recorded.RESULTS:After TLIF without fixation.no obvious changes were found in mean stress and strain,but the axes stiffness and rotational stiffness were significantly decreased,indicating TLIF could produce immediate lumbar stability.After TLIF with unilateral or bilateral transpedicular screws fixation,the lumbar stability was significantly enhanced compared with TLIF alone,especially bilateral transpedicular screws fixadon.Although the lumbar stability following unilateral transpedicular screws fixation was inferior to bilateral fixation,it was still greatly enhanced,even bxceeded normal sample,indicating TLIF with unilateral transpedicular screws fixation could produce enough initiallumbar stability.CONCLUSION:TLIF alone cannot support sufficient initial stability,but TLIF with bilateral and unilateral transpedicular screws fixation can enhance lumbar initial stability.

Objective To study the microscopic changes of white matter and the relationship between white matter changes and cognitive impairment in Alzheimer's disease (AD) using voxel-based analysis of DTI. Methods Thirty-sev?en patients with probable AD,and 32 normal controls(NC) were all examined by MMSE scores, and underwent a diffusion tensor imaging. The value of FA changes and the correlations between FA and MMSE scores were investigated. Results FA reduction was detected in the right frontal, temporal and parietal lobes as well as the thalamus, the bilateral cingu?lum, corpus callosum, precuneus, inferior parietal lobule, inferior patieto gyrus, supramaginal gyrus and hippocampus in AD. FA values in the right cingulum, left corpus callosum, left inferior temporal gyrus and the bilateral inferior parietal lobule, inferior patieto gyrus and precuneus were significantly decreased in AD than in the health control groups (P<0.05, FWE corrected). There was a positive correlation between the values of FA and MMSE scores(P<0.001,uncorrect?ed). Conclusion AD patients have significant reduction of FA values in the specific regions. There is a positive correla?tion between white matter changes and impairments of cognitive function.

Objective: To analyze the medium and long-term effectiveness of microendoscope-assisted minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for lumbar degenerative diseases in comparison with conventional tubular retractor-assisted MIS-TLIF. Methods: Between November 2008 and March 2013, 53 patients with single segment lumbar degenerative diseases were enrolled. According to the different working channel performed, 28 patients were treated by microendoscope-assisted MIS-TLIF (observation group), while the remaining cases received conventional tubular retractor-assisted MIS-TLIF via Wiltse approach (control group). Preoperative baseline data, including age, gender, body mass index, disease etiology, operated level, the ration for requiring bilateral canal decompression, and preoperative visual analogue scale (VAS) socre of low back pain and leg pain, Japanese Orthopedic Association (JOA) score, Oswestry disability index (ODI) score, showed no significant difference between the two groups ( P>0.05). The operation time, intraoperative blood loss, intraoperative fluoroscopy time, postoperative analgesic drug dose, postoperation in-bed time, and perioperative complication incidence were recorded respectively and compared between the two groups. Radiographic evaluation of interbody fusion was performed based on Bridwell grading system at 2 years after operation. VAS scores of low back pain and leg pain, JOA score, and ODI score were assessed before operation, at 2 years after operation, and at last follow-up respectively. Surgical outcome satisfaction was assessed by modified MacNab criteria at last follow-up. Results: When compared with those in control group, both intraoperative blood loss and postoperative analgesic drug dose were significantly decreased in observation group ( P<0.05); similarly, the operation time and intraoperative fluoroscopy time were also significantly increased in observation group ( P<0.05). There was no significant difference of postoperative in-bed time between the two groups ( t=-0.812, P=0.420). Both groups were followed up 6-10.3 years, with an average of 7.9 years. Regarding perioperative complication, its incidence was 14.3% and 20.0% in observation group and control group, respectively, showing no significant difference between both groups ( χ2=0.306, P=0.580). Specifically, there were intraspinal hematoma formation in 1 case, incision infection in 1 case, urinary infection in 1 case, transient delirium in 1 case in observation group. By contrast, there were dural tear and cerebrospinal fluid leakage in 1 case, urinary infection in 1 case, pneumonia in 1 case, transient delirium in 2 cases in control group. Bridwell criterion was used to judge the intervertebral fusion at 2 years after operation, the fusion rates of observation group and control group were 92.9% and 92.0%, respectively, showing no significant difference ( χ2=0.162, P=0.687). At both 2-year postoperatively and last follow-up, the VAS scores of low back pain and leg pain, JOA score, and ODI score were significantly improved when compared with those before operation ( P<0.01), whereas no significant difference between the two groups at either time point was found ( P>0.05). At last follow-up, the results of patients' satisfaction with surgery evaluated by modified MacNab criteria, and the excellent and good rates of the observation group and the control group were 96.4% and 92.0%, respectively, showing no significant difference ( χ2=0.485, P=0.486). Conclusion: The medium and long-term effectiveness of microendoscope-assisted MIS-TLIF are similar to those of conventional tubular retractor-assisted MIS-TLIF for lumbar degenerative diseases. The former operation has the additional advantages in terms of more clear surgical site visually, less intraoperative blood loss, and reduced postoperative analgesic dose, all of which seem more feasible to clinical teaching.